Unlocking the Secrets of Viral Hepatitis: Understanding the 5 Types and Their Impact
Hepatitis is a broad term for inflammation of the liver. There are various causes of hepatitis, but viral hepatitis is the main reason worldwide. There are five types of viral hepatitis: A, B, C, D, and E. Hepatitis B and C cause chronic liver disease that can lead to cirrhosis. Worldwide, 354 million people live with these infections. About 3 million people live with chronic hepatitis B and C infections in the United States. About 90% of people infected worldwide with these viruses are unaware of their infection status. Therefore, early detection and prevention are the key to managing these infections.
Hepatitis A and E can cause acute illness but do not lead to chronic infections. Below we discuss these viral infections in detail.
Spread: through blood, semen, or other body fluids. It can happen through sexual contact, sharing needles, during pregnancy, or delivery. The most common route of transmission is during birth from mother to child.
Symptoms: Most people do not experience any symptoms when newly infected. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain.
Diagnosis: Hepatitis B is easily diagnosed through blood work. Your doctor will check for hepatitis B surface antigen (HBsAg) to see if you have a chronic infection. Other blood tests are available to confirm if you have an acute infection. An ultrasound of the liver is also usually ordered to check for underlying cirrhosis of the liver and liver cancer detection. Most liver cancers happen in the setting of underlying cirrhosis; however, hepatitis B infection can lead to liver cancer without cirrhosis. Hepatitis D is a co-infection that can occur with hepatitis B. Hepatitis D does not cause an infection, on its own.
Treatment: Currently, there are no medications to cure hepatitis B, but they are available to suppress the virus. However, not everyone infected with hepatitis B needs medication. This decision is made by your doctor, based on your blood tests and whether you have cirrhosis or not. If you DO need medication, most people can tolerate them without any significant side effects.
Prevention: vaccination exists for hepatitis B and can provide lifelong protection. It is usually given to all babies at birth. Vaccination can be given to adults also if they are not immunized already.
Spread: similar to hepatitis B through blood, semen, or other body fluids. The transmission rate from mother to child exists but is much lower than that for hepatitis B. In the United States, transmission primarily occurs through drug use and needle sharing. In the last decade, the transmission rate has further increased because of the ongoing opioid epidemic in the US.
Symptoms: Following initial infection, 80% of people do not exhibit any symptoms. Otherwise, common symptoms are fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, pale feces, joint pain, and jaundice.
Diagnosis: For ALL patients above age 18, testing is recommended. Hepatitis C is diagnosed in two steps:
Test for hepatitis C antibody. This antibody will remain positive lifelong for anyone who acquired an infection at any point in their life, even after treatment.
If the antibody is positive, a follow-up test confirms the presence of chronic or active infection.
Treatment: about 30% of patients will spontaneously clear the infection without needing treatment. However, the majority of patients will develop chronic hepatitis C infection. Currently, multiple treatment options are available that will CURE hepatitis C infection. These are simple pill treatments for 2-3 months, and success rates approach close to 100%. These classes of medications are called direct active antiviral (DAA) treatments. Cure of hepatitis C does NOT protect against future infection.
Prevention: NO vaccination currently exists for hepatitis C. Prevention is focused on reducing exposure to the virus by refraining from drug use and/or reducing exposure to used needles.
Hepatitis A and E
Spread: these viruses cause acute hepatitis and generally will not cause chronic hepatitis (some Hepatitis E cases can, though). Transmission is primarily by the fecal-oral route. It is when an uninfected person ingests food or water contaminated with the feces of an infected person. In families, this may happen through dirty hands when an infected person prepares food for family members. Transmission can also occur through close sexual contact (oral-anal sex).
Symptoms: range from mild to severe and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice. These infections can be severe in immunocompromised and pregnant patients.
Diagnosis: specific blood tests for hepatitis A and E exist to diagnose acute infection.
Treatment: there are no specific treatments for these infections. The disease is self-limiting and generally will recover on its own. Recovery can sometimes take weeks.
Prevention: vaccination for Hepatitis A exists and is recommended for everyone. No vaccination exists for Hepatitis E. Otherwise, prevention is focused on maintaining proper hand hygiene and cleaning practices.
Digestive Health Specialists, PA is here to help if you, or someone you know, would like more information, or if you are experiencing any digestive health symptoms and would like further evaluation. Feel free to give us a call at 336-768-6211 or fill out the form below.
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